Cadet enrollment period is underway.  See important Information.

The Chatham Emergency Squad is happy to provide lift assists, round-trip or one-way transports to residents in need, but is only able to provide this service with advance notification.  Each request requires a minimum of two members.  

The transport must be to or from a resident’s home address which must be a private residence. We do not provide interfacility transports for residents of care facilities or between two care facilities. 

Please fill out the below form and we will get back to you as soon as possible.

1
Your Information
2
Patient Information
3
Transport Information
4
Location Informatoin
First Name *
Last Name *
Phone Number *
Email Address
Please fill out your name and phone number before proceeding.
Patient's Name *
Age *
Approximate Weight *
Patient's Mobility: *
Please Describe:
Does the Patient have any of the Following?
Please Describe:
Does the Patient Require Oxygen? *
How Many Liters Per Minute?
I'm Requesting: *
Please Describe What is Needed in as Much Detail as Possible
Is the Patient Fully Cooperative and Willing to be Transported?
Please Explain What We Should Expect:
Pickup Date *
Pickup Time *
0.00
0.00
Pickup Address *
Dropoff Address
About How Long Before We Return to the Pickup Address?
Location Information *
What do we Need to know?
Accessing the Patient *
Is there an Egress (Exit) Downstairs?
Is there an Elevator?
Anything Else we Should Know?

Please do not refresh the page, it may take a up to 30 seconds to submit the form. Thank you.

Scroll to Top